Abstract
Background Methadone maintenance therapy (MMT) is associated with improved HIV treatment outcomes among people who use drugs (PWUD). The extent to which these benefits are sustained in the context of ongoing cocaine use is unclear. We assessed differential impacts of MMT on HIV viral load (VL) suppression in relation to discrete patterns of cocaine use. Methods Data was drawn from ACCESS, a prospective cohort of HIV-positive PWUD in Vancouver, Canada. Generalized linear mixed-effects were used to model the independent effect of MMT on VL suppression across strata of frequency of cocaine injection and crack smoking (≥daily versus <daily), after adjustment for confounders. Results The analysis included 397 HIV-positive opioid users who completed ≥1 study interview between 2005 and 2014. At baseline, 304 (77%) reported participation in MMT, 37 (9%) ≥daily cocaine injection, and 158 (40%) ≥daily crack smoking. In adjusted analyses, MMT remained independently associated with increased odds of VL suppression in both strata of crack smokers (AOR = 3.11, 95% CI: 1.86–5.21 and AOR = 1.48, 95%CI: 1.04–2.09, for ≥daily and <daily smokers, respectively), and among <daily cocaine injectors (AOR = 1.88, 95%CI 1.38–2.56), but not among ≥daily cocaine injectors (AOR = 1.37, 95%CI 0.53–3.49). Longer retention on MMT was positively associated with VL suppression in all strata of cocaine injection and crack smoke. Conclusions Exposure to MMT was associated with increased odds of VL suppression among HIV- positive opioid users regardless of crack use. However, this beneficial effect of MMT was lost among frequent cocaine injectors with shorter retention on MMT.
| Original language | English |
|---|---|
| Pages (from-to) | 211-218 |
| Number of pages | 8 |
| Journal | Drug and Alcohol Dependence |
| Volume | 168 |
| DOIs | |
| Publication status | Published - Nov 1 2016 |
| Externally published | Yes |
Bibliographical note
Funding Information:The study is supported by the US National Institutes of Health (R01-DA021525) and the Canadian Institutes of Health Research (MOP-79297 and RAA-79918). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, which supports EW. MJM is supported in part by the US National Institutes of Health (R01-DA021525). MES is supported by Michael Smith Foundation for Health Research post-doctoral fellowship award and a Canada Addiction Medicine Research Fellowship ( US National Institute on Drug Abuse , R25-DA037756). WS is supported by Michael Smith Foundation for Health Research Scholar Award. JM is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01-DA036307). None of the funders had any role in study design; in the collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Funding Information:
The authors declare no conflict of interest. The University of British Columbia has received unstructured funding from NG Biomed, Ltd., to support MJM’s research. JM has received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare.
Publisher Copyright:
© 2016 Elsevier Ireland Ltd
ASJC Scopus Subject Areas
- Toxicology
- Pharmacology
- Psychiatry and Mental health
- Pharmacology (medical)
